More than ten million young children under the age of five die each year. Most of these deaths occur in sub-Saharan Africa, and are preventable. Without urgent action, the Millennium Development Goal of reducing child mortality by two thirds by 2015 will not be reached.  Child deaths among poor urban populations are significant, and programmes must target the urban poor to reduce child mortality.

Since the 1990s the decline in child mortality in sub-Saharan African countries has slowed or stopped, and in some countries death rates have increased. The main causes of death are malaria, diarrhoea, pneumonia, measles, HIV and AIDS and malnutrition. If well-known and simple solutions, such as mosquito nets and clean water, were targeted at the poor, the goal of reducing child mortality by 67 percent could still be reached.

The African Population and Health Research Center and Southampton University, in the UK, conducted a study looking at child mortality statistics from national surveys in 22 sub-Saharan countries, and compared data from the 1990s with those in the 2000s. It also looked in more detail at data from Kenya and Zambia, to discover the disparities between the health of children living in urban slums and those living elsewhere in the country.

The structural adjustment programmes of the 1980s led governments to abandon agriculture subsidies and projects in favour of rural development. Poor rural families often moved to cities in search of paid employment and city slums expanded. They often lived without toilets, a safe water supply or any medical services including vaccination programmes. To reduce child mortality, basic amenities in urban slums are necessary, and government programmes must target the urban poor.

The study found the following.

• Only five of the twenty-two sub-Saharan countries have recorded a four percent annual drop in urban child mortality, in line with the Millennium Development Goal.
• Twelve of the countries show a very small decline in child mortality while five have seen an increase. 
• In Nairobi City, Kenya, the number of people living in poverty has almost doubled from 27 to 50 percent within a five-year-period. 
• Rural poverty has also increased over the same period in Kenya but only by five percent, from 48 to 53 percent.

The study recommends an expansion of health programmes for clean water, proper sanitation and vaccination in city slums. It also recommends food supplements for malnourished children, and insecticide-treated mosquito nets for regions with high levels of malaria.

Source(s):
‘Progress Towards the Child Mortality Millennium Development Goal in Urban sub-Saharan Africa: the Dynamics of Population Growth, Immunization, and Access to Clean Water’, BMC Public Health 7:218, by Jean-Christophe Fotso et al, 2007 Full document.

Funded by: Wellcome Trust, Hewlett Foundation, Rockefeller Foundation

id21 Research Highlight: 11 May 2008

Further Information:
African Population and Health Research Center
Shelter Afrique Center
Longonot Road, Upper Hill
P.O. Box 10787-00100 GPO
Nairobi
Kenya

Tel: +254 20 2720400/1/2
Fax:   +254 20 2720380
Contact the contributor: jcfotso@aphrc.org

African Population and Health Research Center, Nairobi, Kenya

Other related links:
'Motherhood in the city: poor urban women and maternal health care provision in sub-Saharan Africa'

'Reducing infant and child mortality: what are the ways forward?'

'Labour-saving technology in Ethiopia is increasing child malnutrition'